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Clinician Article

Treatment for mild cognitive impairment: systematic review.



  • Cooper C
  • Li R
  • Lyketsos C
  • Livingston G
Br J Psychiatry. 2013 Sep;203(3):255-64. doi: 10.1192/bjp.bp.113.127811. (Review)
PMID: 24085737
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Neurology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

BACKGROUND: More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration.

AIMS: To systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia.

METHOD: We reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies.

RESULTS: The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning.

CONCLUSIONS: There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Clinically the most useful finding is that cholinesterase inhibitors don`t help. The rest is a call for more research.

General Internal Medicine-Primary Care(US)

This thorough review answers the question of the utility of a pharmacological intervention for mild cognitive impairment. Based on the available data, drugs don`t work. More, focused studies are needed.

Geriatrics

As a geriatrician, treatment of mild cognitive impairment is one of most discussed topics over the past decades. The results of this systematic review give us a clear picture of an evidence-based approach on this topic and suggests that further study is needed to identify new treatments for this widespread condition.

Internal Medicine

I don't think this is news, or at least I hope it is not news to my primary care colleagues. If there are utilization data that show a lot of these MCI patients are being treated with cholinesterase inhibitors, then I would have more enthusiasm for this.

Neurology

In my country, Neiromidin (Ipidacrine) is mostly used for the treatment of mild cognitive impairment. The effectiveness of this treatment is questionable.

Psychiatry

Samples are rather heterogeneous. For pharmacologic treatment, analysis of each domain of cognitive function may be more interesting than global score.

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